Archive 2019

Contraindications Of Vitamins & Prednisone

by Zachery Clem on 2 minutes ago 2 views Writer: Malcolm Nguyen The majority of people that purchase espresso tables will get them to put in their living room. Cytotechnology is the microscopic examine of cells for disease, and cytotechnologists are its skilled practitioners. Most dogs like to cuddle and snuggle and an ideal pair of pajamas will make her feel like she is snuggled up good and comfy. A lot of the analysis that has been performed on this space has been taking a look at the event of cancer in mice. It is actually the study of cells below a microscope to detect cancer and other abnormalities. Hospitals, for-profit laboratories, clinics, public well being amenities, and trade presently have positions open for certified cytotechnologists. Moreover, experienced writers normally deliver content material in time as quickly as you submit your writing request. Remanufactured or refilled Ink Cartridges have been taken apart or refilled by the maker after which put up for sale. 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Price Of Doxycycline At Walgreens

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Why Does This Lupus Patient Have Unilateral Vision Loss?

Why Does This Lupus Patient Have Unilateral Vision Loss? Rare complication in a 44-year-old black woman who also had end-stage renal disease MedpageToday by Kate Kneisel, Contributing Writer, MedPage Today March 18, 2019
A 44-year-old African-American female presents to the emergency department having lost vision in her right eye 4 days previously. She reports fatigue and photophobia, but no eye pain or headache. On questioning, the patient also denies having any joint pain or chest pain, skin rash, or constitutional symptoms. Her medical history includes stable systemic lupus erythematosus (SLE) – as a result of her lupus, she developed kidney inflammation, followed by end stage renal disease. She explains that she recently had a failed renal transplant.
Findings of cardiac, lung, and abdominal examinations are unremarkable. Neurological examination findings are also normal, and cranial nerves I and III-XI are grossly intact. The patient has no clinical or historical signs of systemic infection. Ophthalmologic Examination Right eye: Unable to perceive light; nil near vision and nil color Visual fields to confrontation in temporal field only Left eye: Visual acuity 20/25; near vision a brisk Jaeger 1; color vision intact. Visual fields were full to confrontation; normal optic disc and retinal vasculature Pupils are 3 mm being nonreactive on the right and 1+ reactive on the left, and there is a 2+ right relative afferent pupillary defect; the patient is orthophoric at distance with full ductions, versions, pursuit, and saccadic eye movements Examination shows no significant ptosis, enhanced ptosis, lid lag, or lid retraction Cranial nerves V and VII are intact with normal corneal reflexes; ocular tensions are 12 and 17, respectively, and each eye is normal on slit lamp examination Fundoscopic examination reveals marked optic disc swelling with a markedly diffusely pale optic disc and 1+ retinal venous tortuosity; there are no vitreous cells and no papillary or retinal hemorrhages
Further Workup
Computerized tomography scan does not detect any neoplastic masses, acute infection/brain abscess, or evidence of optic nerve compression. Drug screening and serum electrolytes, as well as complement (C3 and C4) levels, are all within normal limits.
Lab Test Results ( Test Patient (Normal reference range) Erythrocyte sedimentation rate: 61 mm/hour (normal reference range is 0-29 mm/hour) Anti-nuclear ab (antibody) >12 U (<1 U) Anti-ds-DNA ab 294 IU/mL (8 U (<1 U) Anti-phospholipid IgG ab 20.9 GPL (<10 GPL)
Diagnosis and Treatment
Based on the clinical examination findings, the severe vision loss, including no light perception, and elevated titers of several inflammatory markers consistent with a lupus flare, clinicians diagnose the patient with acute optic neuropathy.
The patient is started on high-dose intravenous dexamethasone (250 mg every 6 hours), and within a few hours she begins to recover the vision in her right eye. Within 3 days, she can perceive a hand two feet away in all visual fields.
She is transitioned from IV dexamethasone to oral prednisone (80 mg/day), which is tapered over 3 weeks. However, vision in her right eye never returns to its pre-hospitalization baseline of 20/60-1; a later assessment finds it to be 20/200.
Discussion
This case 1 reports a patient with an active lupus flare who presents with painless vision loss affecting only her right eye, with optic disc edema and elevated antiphospholipid antibody titers. SLE is a complex inflammatory disease involving formation of both antibodies and immune complexes that can trigger a systemic inflammatory reaction. This widespread inflammation is responsible for the multiple organ changes associated with SLE. 2,3
Clinical manifestations that can differentiate SLE patients from healthy people include skin lesions, arthritis, renal disorder, neurologic disorder, and hematologic changes, among others. 2,3
Diagnosis of SLE involves confirmation of four out of 11 diagnostic criteria for SLE developed by the American College of Rheumatology. 2,3 These may be identified on present history and physical or documented at some time in the past.
Test Sensitivity for SLE diagnosis
Blood tests for lupus vary in sensitivity and specificity, and were as follows. 4 Antinuclear antibody: Screening test; sensitivity 95%; not diagnostic without clinical features Anti-double-stranded DNA: High specificity; sensitivity only 70%; level is variable based on disease activity Anti-Smith: Most specific antibody for SLE; only 30-40% sensitivity Anti-Sjögren syndrome (SS) A (Ro)/Anti-SSB (La): Present in 15% of patients with SLE and other connective-tissue diseases
Ocular Manifestations of SLE Common
SLE has ocular manifestations in up to one-third of people affected; because of the thrombotic and inflammatory nature of the disease, almost every anatomical structure of the eye may be affected. 2,3
Symptoms can range from dry eyes (i.e., in secondary SS) to complete vision loss when the retina and optic nerve are affected. Optic neuritis and ischemic optic neuropathy (anterior and posterior) affect only 1% of SLE patients, 5 but can result in complete loss of vision.
Patients with confirmed lupus should have a thorough ophthalmologic examination, including a detailed fundoscopic examination of the blood vessels and nerves. Various findings include eyelid abnormalities, ocular adnexa, keratoconjunctivitis sicca, iridocyclitis, retinal vasculitis, vaso-occlusive disease, choroidopathy, and optic neuropathy. 6
SLE-associated Ocular Diseases
Optic neuritis is usually acute, with painful loss of vision, and due to infarction of the optic nerve secondary to arteriolar fibrinoid necrosis. 7
Optic neuropathy is bilateral, with painless vision loss, with or without optic disc swelling, and due to ischemia affecting the optic nerve head and retrobulbar nerve. 6,7 Conversely (as in this rare case), unilateral vision loss in the presence of antiphospholipid antibodies, secondary to a focal thrombotic event that affects microcirculation rather than a global, vasculitic process. 8
In SLE patients with suspected optic neuritis, advance testing with fundus fluorescein angiography (FFA) can detect retinal vasculature changes, 5 including vasodilation of the peripapillar capillaries and hyperfluorescence. 9 Ischemic optic neuropathies are marked by incomplete capillary and choroidal filling, followed by hyperfluorescence leakage (Figure). A fluorescein angiogram of lupus retinal vasculitis. Prominent features include scattered intraretinal hemorrhages, fluorescein leakage from the optic disc, vascular leakage from the large veins, and peripheral capillary non-perfusion.
Optic neuropathies due to retrobulbar lesions may appear normal on fundoscopy and FFA, necessitating magnetic resonance imaging with gadolinium contrast to diagnose optic nerve enlargement and enhancement. 5,10
Treatment
Immunosuppressive therapy is the mainstay of treatment for both systemic and ocular SLE. 11 SLE optic neuropathy is typically treated with high-dose intravenous methylprednisolone (1 g/day for 3 days) followed by oral prednisone (1 mg/kg/day). 12 Pulse-dosed intravenous cyclophosphamide for 6 months may be an effective alternative 13 in the up to 29% of patients refractory to corticosteroids. 14
Treatment for ischemic optic neuropathy is controversial, especially in the presence of antiphospholipid antibodies, noted the authors of the case report, Alexander J. Heckman, MD, of the Mayo Clinic in Jacksonville, Florida, and colleagues. They said that when visual loss is likely caused by an acute thrombotic event, anticoagulation with warfarin or aspirin should be considered. 11,15
In addition, to prevent thrombosis in the presence of antiphospholipid antibodies in patients with SLE, hydroxychloroquine may be considered. 16
High-dose corticosteroids may be given empirically to treat the systemic autoimmune illness, the team added. 15 Heckman and co-authors explained that they decided to use dexamethasone rather than the standard methylprednisolone due to the higher free plasma levels and central nervous system penetration. 12
Conclusions
Optic neuropathy is a rare, acute, vision-threatening ophthalmic complication of SLE. A thorough patient history and funduscopic examination combined with serological studies are crucial to accurate diagnosis. The authors concluded that understanding the workup and the importance of rapid immunosuppressive treatment, along with awareness of the disease's rare unilateral presentation, may prevent vision loss in SLE patients.
References
1. Heckman AJ, et al "Acute Unilateral Vision Loss Due to Optic Neuropathy in a Patient with Systemic Lupus Erythematosus" Am J Case Rep 2019; 20: 97-100.
2. Tan EM, et al "The 1982 revised criteria for the classification of systemic lupus erythematosus" Arthritis Rheum 1982; 25: 1271–1277.
3. Yu C, et al "Diagnostic criteria for systemic lupus erythematosus: A critical review" J Autoimmun 2014; 48-49: 10-13.
4. Bartels CM "Systemic Lupus Erythematosus (SLE) Workup" https://emedicine.medscape.com/article/332244-workup, Updated: Dec 12, 2018.
5. de Andrade FA, et al "Neuro-ophthalmologic manifestations in systemic lupus erythematosus" Lupus 2017; 26(5): 522-528.
6. Palejwala NV, et al "Ocular manifestations of systemic lupus erythematosus: A review of the literature" Autoimmune Dis 2012; 2012: 290898.
7. Sivaraj RR, et al "Ocular manifestations of systemic lupus erythematosus" Rheumatology (Oxford) 2007; 46(12): 1757-1762.
8. Giorgi D, et al "Optic neuropathy in systemic lupus erythematosus and antiphospholipid syndrome (APS): Clinical features, pathogenesis, review of the literature and proposed ophthalmological criteria for APS diagnosis" Clin Rheumatol 1999; 18(2): 124-131.
9. Vine AK, Barr CC "Proliferative lupus retinopathy" Arch Ophthalmol 1984; 102: 852-854.
10. Uy HS, Chan PS "Systemic lupus erythematosus. In: Foster CS, Vitale A (eds.), Diagnosis & Treatment of Uveitis, 2nd ed" New Delhi: Jaypee Brothers Medical Publishers 2013.
11. Bajwa A, Foster SC "Ocular manifestations of systemic lupus erythematosus" J Clin Cell Immunol 2014; 5: 191.
12. Balis FM, et al "Differences in cerebrospinal fluid penetration of corticosteroids: Possible relationship to the prevention of meningeal leukemia" J Clin Oncol 1987; 5(2): 202-207.
13. Frigui M, et al "Optic neuropathy as a presenting feature of systemic lupus erythematosus: Two case reports and literature review" Lupus 2011; 20(11): 1214-1218.
14. Galindo-Rodriguez G, et al "Cyclophosphamide pulse therapy in optic neuritis due to systemic lupus erythematosus: An open trial" Am J Med 1999; 106(1): 65–69.
15. Tugcu B, et al "Nonarteritic anterior ischemic optic neuropathy as the presenting manifestation of primary antiphospholipid syndrome" Indian J Ophthalmol 2014; 62(5): 642-644.
16. Szymezak J, et al "Hydroxychloroquine: A new therapeutic approach to the thrombotic manifestations of antiphospholipid syndrome" Rev Med Interne 2010; 31(12): 854-857 [in French].
No disclosures were reported.

Cheap-Pharma.com Review: Not Legitimate Online Pharmacy

7 Conclusion: Not Legitimate Online Pharmacy Self-Introduction of Cheap-Pharma.com
Cheap-Pharma.com ensures international service. This store offers brand and generic medications of various conditions’ treatment. This domain belongs to Canadian Pharmacy Ltd. The international license number is 49451121 issued 17 Aug 2017. This company provides verification certificates of CIPA, MIPA. Unfortunately, they are not clickable. As a result, we are going to assess its validity. devoted to a high-quality service by selling the medications meeting all standards of production. Assortment Diversity
Cheap-Pharma offers 27 drug categories. The most popular medication condition is erectile dysfunction. The majority of bestsellers’ list is composed of this category. If you suffer from one of these disorders as allergies, asthma, erectile dysfunction, anti fungal, anti viral, anxiety, arthritis, blood pressure, cholesterol lowering, depression, diabetes, hair loss, heart disease, weight loss, women’s health you are welcome to find meds in these categories suitable for you. There are also birth control, herbals, weight loss, skincare, pain relief, muscle relaxant products and antibiotics.
The list of bestsellers contains the following preparations: Viagra, Cialis, Levitra, Clomid, ED sample pack1, Brand viagra, Doxycycline, Propecia, Amoxil, Viagra Professional, Prednisone, Brand Cialis, Dapoxetine, Zithromax, Nolvadex, Cytotec, Cialis Professional, Viagra Super Active, Extra Super Viagra, Cialis Extra Dosage, Cialis Soft, Viagra Soft, Kamagra, Cipro, Female, Lasix, Zoloft, Tadapox, Xenical, Sildalis.
There is one more option which may reduce the time of searching. You may use alphabetic search or search by name options.
The in-stock assortment of this company is diverse. The overall number of items is impossible for calculation. Finally, our mark is 5 points. Prices Affordability
Generic Viagra price per pill is $0.27. The dosage is 25 mg. The package contains 360 pills. The total is $97.74. The savings are $390.96. This price is reasonable and attractive.
If you want to test Tadalafil you will pay $0.68 per pill. The dosage is 2.5 mg with the package containing 360 pills. The total is $246.48. The savings are $251.47.
The price per generic Levitra pill is $1.00. The dosage is 10 mg. The package includes 360 pills. The total is $360.22. The savings are $881.92.
In fact, we may not believe in so great savings offered by this online pharmacy. There is an additional option which allows changing the currency from US dollar to EUR, AUD, CAD, GBP, CZK, PLN, BGN, HUF, DKK, NOK, SEK, CHF, JPY, RON, CNY.
Our mark for this unit is 4 points. Shipping Options
Cheap-Pharma.com offers an international delivery. The delivery is carried out by 2 main systems: Airmail delivery; Express Courier System.
An airmail delivery timeframe is 2-3 business weeks. The fee is $9.95. Free Airmail delivery is available if your order total exceeds $200.00. Unfortunately, the tracking is not optional when using this system.
Express delivery takes 3-8 business days. The fee is $19.95. The delivery may also be free if your total is over $300.00. The tracking is available by means of ID number.
There is no next day delivery but the possibility to get free international delivery may attract more and more customers from all over the world. Our mark for this unit is 4 points. Payment Options
This online pharmacy accepts Visa and MasterCard. Credit cards are the only way to pay for an order online. Our mark for this unit is 2 points. Technical Characteristics Google Page Speed about the Website Loading
Regretfully, desktop and mobile versions according to Goole Page Speed have unsatisfactory data. Page speed indications are hidden. Optimization is low – 57 and 55 out of 100. Having seen such unsatisfactory indicators, users may definitely suppose the problems with the website loading may easily occur. You may face the problems with the completing an order online. Having used a special formula, we give only 1.3 points for this unit. Mobile Version
Unfortunately, there are some technical drawbacks of the mobile version. Google cannot reach this page. It means that customers cannot be able to complete and pay for an order by means of this online mobile version. Is the Connection Secure?
Regretfully, the connection is insecure. You won’t be protected while commanding this service. There is no “green lock” in the address line.
When you are redirected to secure billing page you are protected by COMODO CA Limited. The encryption key is 256 bit. There is no ownership information. It is the reason for declining the overall rating.
We are glad that even this page is supplied with the secure connection. The data provided by customers and considered private, personal information will be properly encrypted. It will prevent the hackers from gaining access to this data. Our mark for this unit is 2 points. Antivirus Presence
There is no antivirus. This website may be full of viruses and other online threats which may infect your gadget or computer with the spread on the web viruses. How to Make an Order?
There is no consultation, there is no registration. In fact, the ordering procedure is not burdened by anything. You should choose the medication you need means of one of the most convenient methods. Then, you should choose the right dosage and number of pills. Check the shopping cart details and grapple with the shipping information.
There should be done nothing special for ordering. You won’t waste time on getting an access to the medical products.
The only inconvenience is that you are redirected after pressing the checkout page to the secure billing page. The billing page contains all the order details and personal data for completing an order online.
Our mark for this unit is 4 points. Is Cheap-Pharma.com Legit and Secure? ScamAdviser.com about the Website Security Rate
Cheap-Pharma.com is a low-trust rating company. ScamAdviser.com gives 0% of security. The owner country is hidden. The website location is Lithuania. Ukraine may also be involved in the performance of this online service. The organization is Internet Invest, Ltd. dba Imena.ua. The owner city is Kyiv. The phone number and email are registered in Ukraine.
This website uses the service for hiding location. It is not possible for the eCommerce website. All the information should be available for Google and users. The server contains 5 other domains registered in Ukraine and Lithuania.
Moreover, the website is 121 days old. This is not enough for gaining a high-trust pharmacy reputation. There is a chance of the performance improvement if the website will exist for a longer period of time.
This pharmacy, according to this service, It means that it is popular instead of the information given on the website is controversial. Moreover, the website speed is low.
The overall rating is 1 point. Prescription Request
Regretfully, this online service doesn’t require a prescription. All the medications, even those intended for dispensing with a prescription, are sold without its mandatory demand. In fact, in such a way, this pharmacy breaks the rights of customers of getting high-quality medications because there is a suspicion of improper quality of items sold. Is Cheap-Pharma.com Legit?
According to LegitScript.com, Cheap-Pharma.com is not legit. It has assessed as a rough pharmacy. This pharmacy may break the legal laws and regulations intended to be met. There is a high risk to buy counterfeit products sold under brand names. As a result, we cannot give anything but 1 point for the legitimacy of this domain. Verification Certificates
This pharmacy provides the certificates of CIPA and MIPA. After a proper examination, we have come to a conclusion that they are not invalid. These are just icons misinforming people they may be sure when commanding this service. These icons are not clickable. It is the first sign in confirming this idea. Finally, we give only 1 point for this unit. Reviews about Cheap-Pharma.com Reviews on Cheap-Pharma.com
There is a separate page with reviews. Unfortunately, they are non-unique. These reviews are used on other various online pharmacies. We have found almost 5 websites with the same reviews. Moreover, the reviews are non-informative. They contain, in the majority of cases, one-two sentences boosting this online pharmacy as a great one. You may read these reviews but in fact, it won’t help you understand the essence of Cheap-Pharma.com performance. Reviews about Cheap-Pharma.com on the Foreign Resources
Regretfully, we have not found any word about this online pharmacy. There is no feedback left anywhere on the web. People won’t be able to gain any opinion of people who have already commanded this service. As a result, our mark for this unit is 1 point. Discount Code on Cheap-Pharma.com
Cheap-Pharma.com has a special field for a discount code but we have not found any promo code. But there is an option to get free sample pills to every order. You may choose the following combinations: Viagra 100 mg × 2 pills; Cialis 20 mg × 2 pills; Levitra 20 mg × 2 pills; No bonus.
Moreover, there is a free shipping. The regular delivery becomes free if your order is over $200.00. If your order exceeds $300.00 you are welcome to get free express delivery.
We use a contact form to ask the about the possibility to get a discount code. Unfortunately, we have not got an answer yet. Our mark for this unit is 3 points. “Contact Us” Section
The contact section includes only a contact form. The only given information is phone numbers. There are 2 phone numbers: 1-718-487-9792 and 4420-3239-7092. There are no hours of operation specified when you will be able to call this online pharmacy. There is no physical address. You won’t be able to send any letter to Cheap-Pharm.com. Considering all this, we give only 2 points for this unit.
We have used a contact form to get to know how to get a discount code. Finally, we have not achieved a response from the . The waiting period is 46 hours. It is not appropriate to make people wait for such a long period of time. Unsatisfactory mark – 1 point. Conclusion: Not Legitimate Online Pharmacy
Cheap-Pharma.com is an international drug distributor. This company provides brand and generic medications. The prices are reasonable and shipping options are accessible. There are some drawbacks to technical characteristics. There are some technical problems with a mobile version. There is no antivirus.
The legitimacy is poor. ScamAdviser.com gives only 0% of security. LegitScript.com considers the pharmacy rough. The prescription is not required what contradicts the legal law. The reviews are non-unique at Cheap-Pharma. The foreign reviews are even absent.
In fact, we cannot recommend this service. The composed review is the way to understand it is not reliable to visit this website and start ordering. There are much more reliable services offering this or that products online. 2

The “Duchenne Muscular Dystrophy Treatment Market – Growth, Trends, and Forecast (2019 – 2024)” report has been added to ResearchAndMarkets.com’s offering.
The Duchenne muscular dystrophy treatment market is expected to register a CAGR of nearly 47.6% during the forecast period, 2019-2024.
The propelling factors for the growth of the Duchenne muscular dystrophy (DMD) treatment market include the rising disease burden of Duchenne muscular dystrophy, increasing investments in biopharmaceutical R&D to release novel disease therapies, and increasing awareness campaigns for DMD.
Currently, there is an increase in the number of clinical trials for testing the future treatment for Duchenne muscular dystrophy. The only accepted pharmacological therapy for the treatment of DMD is corticosteroid-based anti-inflammatory treatment.
The rising prevalence of chronic diseases, such as cardiovascular and neurovascular diseases, and arthritis, and increasing healthcare insurance coverage are the major factors likely to accelerate the growth of the market. The pharmaceutical drug discovery and development have also grown rapidly in the past few years.
As there have been great breakthroughs in technology in the last few years that may facilitate research processes and as the explosion of science in understanding the causes of diseases has made target selection more rational than ever, almost all major companies are now concentrating on R&D, which is likely to have a major impact on the market in the coming years.
Furthermore, with increasing awareness among people and with the government’s urgency for the treatment of the disease, there is a big opportunity for the companies to conduct their trails and for new drugs launches, due to which, the market is expected to grow in the coming years.
Key Market Trends
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Segment is Expected to Grow Fastest During the Forecast Period
Corticosteroids are the only known pharmacological treatment for DMD and help to suppress muscle inflammation. This treatment is being limited by its inadequate therapeutic efficacy, and considerable side effects, and hence, non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce the inflammation of muscles. The nonsteroidal anti-inflammatory drugs are expected to witness a CAGR of 49.2% over the forecast period.
However, other therapies and treatments include stem cell therapy, repurposing drugs, anti-fibrotics, myostatin inhibition, gene editing (CRISPR/Cas9), etc. Currently, prednisone/prednisolone and deflazacort have been used for the treatment of Duchenne muscular dystrophy, which is expected to drive the growth of the market, over the forecast period.
North American Region holds the Largest Market Share of the Market Currently and is Believed to Follow the Same Trend Over the Forecast Period
North America dominates the global Duchenne muscular dystrophy market, due to new product innovations, high healthcare expenditure, and government awareness programs.
The United States has dominated the regional market and is projected to maintain its lead, owing to the rising disease incidence and anticipated launch of promising pipeline candidates. In addition, the market is expected to grow with the increasing clinical trials around the world, especially in the United States and Europe.
Competitive Landscape
With increasing campaigns and awareness programs, the number of patients is expected to come down, and hence, many companies are conducting campaign programs that help to improve focus on medicines for DMD treatment. There are also very few companies for new drug research for rare diseases because it needs bigger funds.
Therefore, the market is not well established in many other therapeutic areas. However, it is expected to experience high growth and expand during the forecast period.
Topics Covered
1 Introduction
1.1 Study Deliverables
1.2 Study Assumptions
1.3 Scope of the Study
2 Research Methodology
3 Executive Summary
4 Market Dynamics
4.1 Market Overview
4.2 Market Drivers
4.2.1 Rising Disease Burden of Duchenne Muscular Dystrophy (DMD)
4.2.2 Increasing Investments in Biopharmaceutical R&D to Release Novel Disease Therapies
4.2.3 Increasing Awareness Campaigns for DMD
4.3 Market Restraints
4.3.1 Lack of Standardization to Measure Clinical Efficacy Across All Stages of DMD
4.3.2 Stringent Regulatory Framework with High Product Cost Burden
4.4 Porter’s Five Forces Analysis
5 Market Segmentation
5.1 By Therapeutic Approach and Treatment Type
5.1.1 Molecular-based Therapies
5.1.1.1 Mutation Suppression
5.1.1.2 Exon Skipping
5.1.2 Steroid Therapy
5.1.2.1 Corticosteroids
5.1.3 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
5.1.4 Other Therapeutic Approaches and Treatment Types
5.2 By End User
5.2.1 Hospitals/Clinics
5.2.2 Ambulatory Centers
5.2.3 Other End Users
5.3 Geography
5.3.1 North America
5.3.2 Europe
5.3.3 Asia-Pacific
5.3.4 Middle East & Africa
5.3.5 South America
6 Competitive Landscape
6.1 Company Profiles
6.1.1 BioMarin
6.1.2 Bristol-Myers Squibb Company
6.1.3 Fibrogen Inc.
6.1.4 Eli Lilly and Company
6.1.5 Nobelpharma Co. Ltd.
6.1.6 NS Pharma Inc.
6.1.7 Pfizer Inc.
6.1.8 PTC Therapeutics
6.1.9 Santhera Pharmaceuticals
6.1.10 Sarepta Therapeutics
7 Market Opportunities and Future Trends
For more information about this report visit https://www.researchandmarkets.com/research/wjfvvk/global_duchenne?w=4

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STOPPING CERTAIN MEDS ABRUPTLY CAN BE DEADLY
Have you ever had a friend tell you that they stopped taking their anti-depressant because they feel happy now? Or what about the boyfriend who stops taking his high blood pressure meds because, “everything is fine, and he’s working out and eating right?” Lastly, how you ever suffered from anxiety and been prescribed Valium or Clonopin and abruptly stopped taking it because you were no longer anxious? If any of these are familiar scenarios, know that abruptly ceasing certain medications at best, can make you sick, and at worst can cause death. We turned to Dr. Niket Sonpal an NYC Internist and Gastroenterologist and Dr. Duy Nguyen, a Psychiatrist at Beachway Drug and Alcohol Center in Florida. With their combined expertise, they explain the prescription drugs that are dangerous to stop without consulting a doctor and tapering down. See if one your meds is on this list!
Blood Pressure Medications
Medication to control high blood pressure only works if you take it. If you stop taking anti-hypertensive medication without discussing it with your doctor, you put yourself at risk for a stroke. High blood pressure is the most important preventable risk factor for stroke, according to the American Heart Association (AHA) and the American Stroke Association (ASA). Dr. Sonpal says that “The higher the blood pressure, the higher the risk for stroke and other health consequences such as brain aneurysm. Unfortunately, some people with high blood pressure stop taking their medication. If their blood pressure returns to normal, they may feel that they no longer need the medication. But normal blood pressure means the medication is doing its job; halting medication will allow blood pressure to rise again, putting the person at risk for stroke and other complications of hypertension.”
Antidepressants
Dr. Duy Nguyen has seen many a patient stop taking drugs such as Prozac, Wellbutrin, Celexa, and Zoloft without first consulting with him. He is adamant that patients don’t go this route. He says, “Withdrawal from antidepressants can cause insomnia, confusion, anxiety, panic, agitation, nightmares and worsened depression. People may also experience fatigue, nausea, vomiting, dizziness, muscle spasms, headaches and loss of coordination. If you wish to be off of an anti-depressant or switch to another, speak to your doctor first and have them devise a safe schedule to titrate you down and/or replace with another.”
Benzodiazepines
You are likely familiar with these under the brand names Valium, Clonopin, Xanax, and Ativan. These are most commonly used to treat anxiety and panic. For people who only take these once in a blue moon (for fear of flying or public speaking), the body and brain are not addicted. For those who take one or more of these medications daily, they cannot be stopped cold turkey! Dr. Nugyen strongly cautions that, “ Benzodiazepine drugs can cause serious withdrawal symptoms including seizures, tremors, hallucinations, heart palpitations, insomnia, nausea, and increased anxiety. If you wish to stop or reduce your intake of these drugs, consult with your doctor to develop a titration schedule. If you have been taking high doses of these drugs over a long period of time, you may need more supervised medical support such as a drug detox program where you are monitored 24/7 by nurses and given supplementary non-benzo medications to ease withdrawal symptoms.”
Prednisone and other steroids.
Prednisone is prescribed as a potent anti-inflammatory for a variety of conditions, including asthma, allergies, hives, inflammatory arthritis and gout. If you’ve been taking prednisone for more than one to two weeks and just stop it, you may get into trouble. Dr. Sonpal explains that “When you are taking prednisone tablets, your own adrenal gland production of cortisol declines. When you abruptly stop taking prednisone, the result may be low cortisol. This causes weakness, nausea, vomiting, diarrhea and abdominal pain. It’s not fun and can be very serious. Wean off of it under the schedule determined by your doctor”
Antibiotics
Too often patients with a bacterial infection begin a course of antibiotics with every intention of following their doctor’s orders, then cutting their treatment short when they’re feeling better. “What they don’t realize is that this can cause problems in the future. Antibiotics are prescribed in the dose that ensures every last bit of the targeted bacteria in your body will be destroyed,” explains Dr. Sonpal. He adds. “If you stop taking your antibiotics a few days before you’re supposed to, any remaining strains of the bacteria, the ones that were already strong enough to make it through the first few doses of the medicine, will survive in your system, and will be resistant the next time you take those same antibiotics.”
Opioid pain medications. Opioids are prescription analgesics like codeine, morphine, and hydrocodone (an active ingredient in Vicodin), and if you’ve been taking any of them long term, abrupt discontinuation can cause symptoms like diarrhea, generalized pain, restlessness, and anxiety. “Withdrawing from opioids is no joke,” says Dr. Nguyen. He adds, “Depending on your level of addiction, a patient may need in-patient medical detox followed by a drug rehab program, the latter of which will deal with the emotional aspects of eliminating the addiction.”
Diabetes Medication
When your blood sugar seems to be under control, you may decide you want to stop taking your diabetes medications. Dr. Sonpal explains that “If you’re a type 1 diabetic, your body will never be able to create its own insulin, so it’s pretty clear that you can never stop taking insulin. But if you’re a type 2 diabetic, you may be able to explore alternatives with your physician. Since this type of diabetes evolves and changes over time, you need to consistently evaluate your treatment plan with your doctor.” This could involve reducing the dose of your current medication or trying newer medications. But it’s imperative that you not take any action on your own with regard to adjusting your medication without first consulting with your physician.
Thyroid Medication
If you have hypothyroid—whether due to Hashimoto’s, Graves’ disease treatment, thyroid surgery, or congenital hypothyroidism—failing to take your thyroid hormone replacement medication can pose many risks to your health. If you don’t feel better after taking your medication for several months, you may need a dosage adjustment or a change in medication—not a complete stop of your regimen. Dr. Sonpal explains that “There isn’t a natural or herbal replacement for thyroid hormone. Much like patients with type 1 diabetes and their need for insulin, your system needs thyroid hormone for survival. But there are no natural substitutes for antithyroid medications.”
Some Risks of Ceasing Thyroid Medicine Include:
Blood pressure irregularities
Elevated cholesterol, including treatment-resistant high cholesterol and increased risk of heart disease
Low body temperature; feeling perpetually cold
Fatigue, muscle weakness, or joint pain
Depression
About Dr. Niket Sonpal: https://tourocom.touro.edu/academics/faculty/harlem/niket-sonpal.php
Dr. Niket Sonpal is an Adjunct Assistant Professor at Touro College of Osteopathic Medicine and Clinical instructor at Kingsbrook Jewish Medical Center, Brooklyn who specializes in Gastroenterology. He is a graduate of the Medical University of Silesia – Hope Medical Institute in Poland. After completing his residency in Internal Medicine at Lenox Hill Hospital, he was selected to be the 2013‐2014 Chief Resident at Lenox Hill Hospital–Northshore LIJ Health System. Dr. Sonpal has completed his Fellowship in Gastroenterology & Hepatology at Lenox Hill Hospital and continues his work in the field of medical student and resident test preparation. He now serves as the associate program director for the Internal Medicine Residency Program at Brookdale University medical center.
He is the co‐author for the best-selling Master the Boards: USMLE Step 2 CK, Master the Boards Step 3, And Master the Boards: Internal Medicine. He is also the Chief Operating Officer for Medquest Test Prep, Director of Medical Education for Picmonic Test Prep, and a recognized expert on medical test prep.
About Beachway Therapy Center:
www.Beachway.com
Beachway provides a continuum of care, from PHP (Partial Hospitalization Program) to Outpatient services. The facility offers a fully individualized treatment plan that meets the clinical and medical needs of each client usually lasting between 30 and 90 days. Beachway provides an extremely low client to therapist ratio and under high-level professional supervision, clients can begin to recover in a safe, residential-like environment. CBT (cognitive behavioral therapy) motivational interviewing, addiction counseling, 12-Step orientation, DBT (dialectical behavioral therapy,) trauma-informed practices and a wide variety of supportive group therapies are offered.
About the Doctor:
Dr. Duy Nguyen, D.O.
Dr. Duy Nguyen, D.O. is a Board Certified Psychiatrist in General Psychiatry who has experience with providing psychiatric care in a variety of settings including residential drug and alcohol rehabilitation, inpatient and outpatient mental health, and the VA Medical Center. Dr. Nguyen obtained a Bachelor’s Degree from the University of Kansas, a Doctor of Osteopathic Medicine Degree from the Kansas City University of Medicine & Biosciences, and completed general psychiatry training in South Florida at the Palm Beach Consortium for Graduate Medical Education at University Hospital in Tamarac, FL. Dr. Nguyen is committed to providing a high level of evidence-based psychiatric care in the drug rehabilitation setting in addition to having a holistic focus on healing and recovery. Leave a Reply Your email address will not be published. Required fields are marked * Comment